Department of Cardiac Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic.
Kardiol Pol. 2011;69(3):213-8.
Standard (conventional) coronary artery bypass grafting (CABG) is an invasive procedure which requires full median sternotomy and is performed with extracorporeal circulation (ECC), which can lead to serious complications.
To analyse the results of minimally invasive CABG (MIDCAB) in elderly patients.
Between 1999 and 2007, a total of 698 MIDCAB procedures were performed at our institution. We present the data on 235 elderly (≥ 70 years) patients (160 males, mean age 74.5 ± 3.2 years, range: 70-83 years) who were consecutively operated on in this period. Early mortality, post-operative complications, long-term survival, impact of multivessel disease (MVD) and hybrid coronary artery revascularisation on total mortality were analysed. Logistic EuroSCORE was 8.7%. The survival of 235 elderly patients was compared to the survival of the remaining 463 MIDCAB patients aged < 70 years (including risk factors for total mortality).
The 30-day mortality was 2.5% (six patients). During follow-up, two patients underwent coronary reoperation and percutaneous coronary intervention (PCI) was performed in 16 patients. Kaplan-Meier analysis revealed a 1.5-year survival of 89.8% (95% CI 85.9-93.7%) and five-year survival of 79.7% (95% CI 74.3-85%). Compared to single vessel disease (SVD) patients, the MVD patients had significantly higher total mortality (p = 0.0038). Our study revealed MVD (p = 0.0016) and male sex (p = 0.0091) as important independent factors of total mortality in this group of elderly patients. The difference in total mortality between non-hybrid vs hybrid MIDCABs was not significant (p = 0.63). The younger MIDCAB patients (< 70 years) have a tendency to better survival, but the difference did not achieve statistical significance (p = 0.088). They had the same independent factors of total mortality as in the elderly group: MVD (p = 0.0001) and male sex (p = 0.0059).
The MIDCAB is a reasonable option for elderly patients with SVD, and in selected patients with MVD. The decision to perform MIDCAB rather than PCI in these high risk patients should always be very carefully considered in conjunction with the interventional cardiologist.
标准（常规）冠状动脉旁路移植术（CABG）是一种有创性手术，需要完全正中劈开胸骨，并在体外循环（ECC）下进行，这可能导致严重的并发症。
分析微创冠状动脉旁路移植术（MIDCAB）在老年患者中的结果。
在 1999 年至 2007 年期间，我们机构共进行了 698 例 MIDCAB 手术。我们报告了在此期间连续进行手术的 235 例老年（≥70 岁）患者（160 例男性，平均年龄 74.5±3.2 岁，范围：70-83 岁）的数据。分析了早期死亡率、术后并发症、长期生存率、多血管疾病（MVD）和杂交冠状动脉血运重建对总死亡率的影响。逻辑 EuroSCORE 为 8.7%。将 235 例老年患者的生存率与其余 463 例年龄<70 岁的 MIDCAB 患者（包括总死亡率的危险因素）的生存率进行比较。
30 天死亡率为 2.5%（6 例）。在随访期间，2 例患者再次接受冠状动脉手术，16 例患者接受经皮冠状动脉介入治疗（PCI）。Kaplan-Meier 分析显示，1.5 年生存率为 89.8%（95%CI85.9-93.7%），5 年生存率为 79.7%（95%CI74.3-85%）。与单血管疾病（SVD）患者相比，MVD 患者的总死亡率显著升高（p=0.0038）。我们的研究表明，MVD（p=0.0016）和男性（p=0.0091）是该组老年患者总死亡率的重要独立因素。非杂交 MIDCAB 与杂交 MIDCAB 之间的总死亡率差异无统计学意义（p=0.63）。年轻的 MIDCAB 患者（<70 岁）有更好的生存趋势，但差异无统计学意义（p=0.088）。他们与老年组有相同的总死亡率独立因素：MVD（p=0.0001）和男性（p=0.0059）。
MIDCAB 是 SVD 老年患者和选定的 MVD 患者的合理选择。在这些高危患者中，决定进行 MIDCAB 而不是 PCI，应始终与介入心脏病专家仔细考虑。
